Rotator Cuff Therapy & Treatment

What is a Rotator Cuff Tear?

The rotator cuff of the shoulder is a group of 4 muscles (the suprasprinatus, subscapularis, infraspinatus and teres minor) that surround the uppermost part of your arm (the humerus bone). Together the rotator cuff muscles form a suction force that pulls the humerus into the shoulder blade and keeps the joint stable during arm movements.Rotate Cuff Tear Thearapy

Sometimes, the rotator cuff can be injured – strained, inflamed and torn when loads are given to the shoulder that it is unable to handle. These activities may include heavy weight lifting, repetitive arm movements, or a sudden jolt to the shoulder like a fall or a car accident.

Injuries to the rotator cuff are quite common but they are more common in older adults because of their shoulders being weaker and more deconditioned, so simple activities like falling or being pulled on the dog’s leash can sometimes cause a tear. If rotator cuff tears are left untreated, they could cause severe pain and disability, rendering the arm and shoulder unable to be used.   

Severity of rotator cuff tears can be classified as full-thickness or partial-thickness, judging on how extensive the tear is through the muscle. Full-thickness tears is exactly how it sounds: a tear extending from the top to the bottom of the muscle or tendon. Partial-thickness tears involve a disruption of the muscle or tendon through some portion, but the damage does not extend all the way through the structure.

As mentioned earlier, rotator cuff tears can either develop through traumatic and sudden injury from an event, or may develop over time with repetitive overhead use. These can then be classified as acute and as chronic rotator cuff tears respectively.

Patients with chronic rotator cuff injuries often have histories of shoulder impingement syndrome, with involves a chronic and repetitive irritation of the rotator cuff tendon through repetitive use and poor postural and scapular mechanics.  

Because of the complex mechanism of acute injuries, and also because of chronic compensations of other muscles and structures, rotator cuff tears can also occur in conjunction to other shoulder injuries such as biceps tendonitis and labral tears (the labral being a ring of cartilage surrounding the inside of the shoulder blade that faces the humerus).   

Symptoms of a Rotator Cuff Tear

Following are what patients typically feel with a rotator cuff tear:

  • Pain on top of the shoulder or a radiation of pain down the side of the upper arm
  • Shoulder weakness
  • Loss of shoulder range of motion

Patients often describe the injured arm as feeling weak, heavy and painful while lifting. In severe full-thickness tears, the pain may completely stop patient from performing their daily activities because of the inability to raise the arm. Other telltale signs of a rotator cuff tear disorder is the inability to reach high shelves or overhead, reach behind their backs, tuck in their shirts, or fasten their bra.

How Is A Rotator Cuff Tear Diagnosed?

Contrary to what most patients think, a physical therapist is well equipped in their training and knowledge to hone in on a rotator cuff tear diagnosis. Your PT will gather a subjective report from you about your health history, your pain levels, functional limitations and what we in Stride Strong PT like to call your ‘asterisk sign’ – a repeatable and symptomatic motion that elicits the shoulder pain.

Your physical therapist then will conduct a series of tests to measure the strength and range of motion deficits on your shoulder injured shoulder. Additionally,he/ she will perform some specialized tests that could further narrow in on the injured tendon in question and, with a degree of accuracy, tell whether there is a rotator cuff tear involvement. Some of these tests include Neer’s impingement sign, Hawkins-Kennedy test, the belly press test, and the external rotation lag sign. A lot of these tests aim to elicit the exact same pain that patients are feeling to delineate which tendons are involved; and they usually involve the patient moving through a certain range, sometimes against resistance, at a specific angle of elevation. The eliciting of pain does not cause extra damage that wasn’t already there, but biases the exact tendon of the rotator cuff so the therapist is able to ascertain which movements the patient should avoid.   

In some cases, such as in the suspicion of a full thickness tear, your physical therapist may need to refer out to an orthopedic surgeon for further diagnostics and treatment. An MRI, or madnetic resonance imaging, exam would be able to further show the severity of the shoulder injury and the need for surgical intervention.

Physical Therapy for a Partial-Thickness or Chronic Rotator Cuff tear?

When a partial-thickness rotator cuff tear is diagnosed and surgery is not recommended initially for the treatment of your tear, your physical therapist will get to work on a plan of care to restore range of motion, strength, scapular stability and posture so you can return to daily activities and sports activities with less symptoms. Oftentimes, activity modification is needed in the beginning so the offending structure is not strained even more. There is also a significant amount of muscle guarding and neck tension that happens in conjunction with a rotator cuff tear, and although intuitive at first, could cause significant secondary discomfort. Your physical therapist will be able to give you the postural changes and exercises needed to prevent this.

If the surgical route is chosen by your healthcare team, your physical therapist can also help to jump-start healing and strengthening even pre-operatively to make sure those guarding and compensatory mechanisms are not present when you start rehab after surgery.

It is always the most prudent to seek out a physical therapist or a physician after the onset of a traumatic shoulder injury. Not only can fast intervention allow for fast healing, but also other life-threatening disorders can be ruled out by your healthcare professional.

Physical Therapy for Post-surgical Repair of the Rotator Cuff

A full-thickness tear of the rotator cuff usually warrants surgical intervention to repair the tear. Physical therapy is a vital part of healing after the surgery. The newly stitched and repaired rotator cuff is vulnerable to re-tear after shoulder surgery and physical therapists are equipped with the knowledge on how to safely progress movement and use of the injured shoulder. Close communication with the physician is made so as to follow the surgeon’s protocol for after-surgery care.

During the initial stages after a rotator cuff repair, a patient is usually supported in a sling. The early stages of physical therapy involve gaining range of motion and decreasing post-surgical pain within a safe range, always respecting the healing of the rotator cuff.  As the patient’s range of motion progresses, light strengthening exercises are prescribed to you by your PT to strengthen the scapular muscles and the rotator cuff in a very gradual manner. During this stage, however, the patient may still have a lot of trouble accomplishing daily tasks like bathing, dressing and cooking. Sleeping may be difficult and your physical therapist can arm you with some tools and suggestions to minimize pain and maximize function, while letting the tear heal. Your physical therapist may use gentle massage to calm down hypertonic muscles, and may use a combination of cold therapy and electric stimulation for pain relief. Although these visits may not be completely comfortable and pain-free, not going through with the physical therapy protocol in an adequate amount of time may result in debilitating frozen shoulder syndrome.

Once the patient is out of the sling and tolerating more activity, prescribed exercises will become a little more difficult qw your physical therapist progresses you. Scapular stability is more of a pressing issue so proper shoulder mechanics can start to restore. The patient may be able to do some active moving of the arm, but heavy lifting of weights must be avoided as the tear is still healing. Hands-on mobilization of the arm and shoulder is still needed at this stage to keep working on healthy range of motion.

The last phase of shoulder rehab focuses on return to work and sports. Because the demands for different people vary, the amount and intensity of exercise will also vary. It is important at this stage for the patient to communicate the several common tasks that the patient routinely undergoes so that the same motions and loads are practiced in the clinic under guidance of the physical therapist. Pt visits may be less frequent at this stage as patients are given a more intense home or gym program for strengthening. For return to sports, a series of challenging maneuvers can be continually tested to make sure the athlete is ready to take on the loads of his/her sport.

What If I don’t have a tear, but just shoulder impingement. Is there anything I can do?

A rotator cuff physical therapist can help decrease minimize the progression of a shoulder impingement into a rotator cuff tear. Here is what can be done in PT:

  • Rotator cuff and periscapular strengthening is very important in preventing further damage on the offending tendon.
  • Avoidance of certain overhead motions in certain angles can help decrease the stress on the tendon.
  • Posture re-education. A rounded shoulder posture can further exacerbate shoulder impingement and sets the patient up for a future tear. It is vital to restore proper posture during daily habits, especially during overhead motions.

Book an appointment to visit one of our Portland Clinics and get your rotator cuff therapy today!

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Alice Holland, DPT

Doctor of Physical Therapy, Director at Stride Strong Physical Therapy
Alice earned her Doctorate of Physical Therapy from USC in 2007, and have practiced Physical Therapy for 12+ years in the Outpatient Orthopedic Setting. Certified in ASTYM, she also has been a featured expert on Physical Therapy on numerous publications including health.com, healthline.com and yahoo.com.
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Latest posts by Alice Holland, DPT

Ana Lucia Pinheiro
Ana Lucia Pinheiro
02:18 20 Oct 17
This place is amazing. I am so happy I found Stride Strong PT. Alice pays attention to all of the details, she watches every single move I make, my posture, and the way I move through every exercise. She is very knowledgeable, she was able to pin-point the problems in my back and she has a plan to help me become stronger where I need. The place is brand new, huge, and has nice exercise machines. I tried a few physical therapists in the area, and Alice is TOP, second to none, and I feel super lucky to have found her. Highly recommended!!
Prashant Gupta
Prashant Gupta
01:00 02 Oct 17
Dr. Alice at Stride Strong is one of the best PTs I have come across. Her attention to detail and assessment of the root cause of injury is very good. She is excellent in evaluating pain patterns and giving a training schedule for a rehab & injury prevention, she is extremely knowledgeable. I would strongly recommend Stride Strong to anyone looking for PT. It is easily the best PT clinics in Hillsboro area.
steven zollin
steven zollin
20:57 14 Sep 17
Highly recommend Stride Strong Physical Therapy , Alice showed me proper form to assist in recovery with my shoulder and is very knowledgeable.
Lindsay Nied
Lindsay Nied
23:33 18 Dec 17
I recently had a massage from Joel at the Hillsboro location. He was able to work on an ongoing issue I have been experiencing with my back after a sports injury, and I left feeling so much better. The whole facility looked incredible, and everyone I met was friendly and welcoming. I would highly recommend Stride Strong for massage and physical therapy.
JoAnn Hatch
JoAnn Hatch
08:20 08 Nov 17
Dr. Sydney is by far the absolute best physical therapist I've worked with ever! Her expertise in designing highly effective and efficient exercise plans is beyond compare. I feel so much better as my strength and function increases. She comes up with the most brilliant and fun ideas to motivate. To my delight she even offered to come to my home in Vancouver and work with me on my own equipment including a Stott Pilates Reformer. Talk about going above and beyond! Couldn't be more grateful I found her!!!
Clare Perry
Clare Perry
21:58 23 Oct 17
A full hour of a dedicated PT professional's time without aides or techs? That's just one of the things that sets this clinic apart from others. Competent, professional, and amiable, Dr. Alice Holland and her team are the best in the area. While I generally see them at the Cedar Mill Clinic on Cornell, situational constraints took me to their new Hillsboro clinic today near Intel Jones Farm. Beautifully furnished, spacious with easy parking and access. May you continue to grow and thrive, Stride Strong!
Joyce Heideman
Joyce Heideman
08:28 11 May 18
After foot surgery I went to Stride Strong for therapy with Alice Holland. She helped me reach my full mobility again by continuously introducing new and challenging exercises. The entire staff is friendly and professional. They are always on time and do not rush. I look forward to doing 1/2 marathons again and riding my recumbent trike. Thank you Stride Strong for your care and high level of expertise.
Suad Daher
Suad Daher
20:48 28 Feb 18
The best physical therapy ever. Both JP and Sydney were a great PT, they helped me understand how I can help treat my injury and how it may have caused. And also they informed about so many techniques that I can use to help my injuries or any other injuries I get in the near future. They are both friendly and nice to talk too, and verbunformative. And there is also Krystal, she is the best front desk receptionist ever, she is nice and friendly and can easily manage your schedule based on the patients comfort if they want to schedule or not. She can help and she replies fast to any patients email. And she is easy to talk to. Thank you Stride Strong Physical Therapy.
Amanda O'Rourke
Amanda O'Rourke
21:38 15 Jun 18
In just a month I've seen great progress! I've been incorporating the exercises taught to me into my daily workout routine. Im very happy with my continued results.
Albert Szal
Albert Szal
23:43 10 Jun 18
Mary Szal here: I've had three sessions with Brittany at the Hillsboro location. I can say that she has been the most effective and instructive physical therapist I've ever experienced. Her personality, energy, knowledge and results are top notch.
Osa Phiangdae
Osa Phiangdae
00:05 22 Mar 18
Awesome place for PT. Hillsboro location has plenty of parking and very spacious. I had the pleasure to work mostly with Dr. Alice Holland and JP. I came in with a shoulder injury and thank goodness they understood what I was going through. They are the best of what they do, I would recommend Stride Strong to anyone who needs PT.
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